G. Oppenheimer Center for the Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
G. Oppenheimer Center for the Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Center of Health Research, School of Public Health, Loma Linda University, Loma Linda, California.
Clin Gastroenterol Hepatol. 2019 Oct;17(11):2245-2252. doi: 10.1016/j.cgh.2018.12.029. Epub 2019 Jan 4.
BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is a stress-sensitive disorder associated with dysregulation of the hypothalamic-pituitary-adrenal axis. We studied the cumulative effect of events during adulthood on this pathway in patients with IBS. METHODS: We studied 129 patients with IBS, based on Rome III criteria (mean age 28.1 years, 66% women), and 108 healthy individuals (controls; mean age 29.8 years, 60% women) who completed the Life Experiences Survey from August 2013 to September 2017. Data were collected on the presence and effects of events since age 18, IBS severity scores, and IBS-related quality of life. For a subset of subjects, we measured serum cortisol and adrenocorticotropic hormone (ACTH) production in response to administration of corticotropin-releasing factor and ACTH. RESULTS: Compared with controls, patients with IBS perceived more adulthood life events as negative and had a significantly higher negative life event impact score (14.17 ± 12.04 vs 10.83 ± 9.98; P=.022). In patients with IBS, the presence of more-negatively perceived adulthood life events was associated with worse IBS symptom severity (β = 1.53, 95% CI, 0.21-2.84; P = .025) and IBS-related quality of life (β = -0.70; 95% CI, -1.02 to -0.38; P < .001). Negatively perceived adulthood life events were associated with reduced production of ACTH in response to corticotropin-releasing factor in patients with IBS compared with controls (P < .05). CONCLUSION: In a study of more than 200 subjects, we associated more-negatively perceived events during adulthood with an increased risk for IBS, worse symptom severity and quality of life, and a dysregulated stress response. Understanding the effects of events that cause stress in adults and their perceived effects on IBS may help guide disease management.
背景与目的：肠易激综合征（IBS）是一种与下丘脑-垂体-肾上腺轴失调相关的应激敏感障碍。我们研究了成年期事件对 IBS 患者该途径的累积影响。
方法：我们研究了 129 名基于罗马 III 标准的 IBS 患者（平均年龄 28.1 岁，66%为女性）和 108 名健康对照者（平均年龄 29.8 岁，60%为女性），他们在 2013 年 8 月至 2017 年 9 月期间完成了生活经历调查。收集了自 18 岁以来事件的存在和影响、IBS 严重程度评分和 IBS 相关生活质量的数据。对于部分受试者，我们测量了皮质醇和促肾上腺皮质激素（ACTH）在促肾上腺皮质释放因子和 ACTH 作用下的产生情况。
结果：与对照组相比，IBS 患者认为更多的成年生活事件是负面的，且具有明显更高的负面生活事件影响评分（14.17±12.04 比 10.83±9.98；P=.022）。在 IBS 患者中，更多被感知为负面的成年生活事件的存在与更严重的 IBS 症状严重程度相关（β=1.53，95%CI，0.21-2.84；P=.025）和 IBS 相关生活质量（β=-0.70；95%CI，-1.02 至-0.38；P<.001）。与对照组相比，IBS 患者对促肾上腺皮质释放因子的反应中，被感知为负面的成年生活事件与 ACTH 的产生减少相关（P<.05）。
结论：在一项超过 200 名受试者的研究中，我们发现成年期更多被感知为负面的事件与 IBS 风险增加、更严重的症状严重程度和生活质量以及应激反应失调相关。了解导致成年人压力的事件及其对 IBS 的感知影响可能有助于指导疾病管理。
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